3 Drug Classes and Side Effects That Send More Seniors to the ER

Male doctor examining a senioe woman in hospital ward

Side effects of drugs, many of them part of a daily regimen for older adults, are landing more seniors in the ER today compared to before.

This is part 1 of a 2-part series on drugs whose side effects send seniors to the emergency room. Part 2 is available on our blog

There are more seniors living today than before, and they are also on more medications. But the number of visits they make to emergency departments of hospitals has increased much more than would be expected, and too many are arriving in the ER because of adverse reactions to drugs. Adverse drug reactions is doctor-speak for side effects of a medicine or two medicines that, when combined, can cause new side effects.

Blood thinners, diabetes medications and opioid painkillers are taken routinely by many seniors. These 3 classes of drugs were responsible for 60% of all ER visits that seniors made for adverse drug reactions. And seniors now represent 34% of all adverse reaction trips to the ER, compared to 2005-06 when they accounted for about 26% of such visits.

Researchers from the Centers for Disease Control and Prevention (CDC) discovered this when they studied data for 42,585 patient visits to the ER in 2013-14, based on information collected by the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. They published their findings in JAMA in November 2016.

Adverse reactions to anticoagulants or blood thinners have led to bleeding or hemorrhaging. You can lower the risk of this happening in several ways, including avoiding taking drugs that also increase the chances of bleeding, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen).

Reactions to diabetes drugs have led to hypoglycemia (low blood sugar), with moderate to severe neurological effects. Sulfonylureas, such as Amaryl (glimepiride) and Glucotrol (glipizide), in particular, are associated with hypoglycemia.

Medication Errors Impact About 7 Million Patients Annually

Medication errors that might lead to adverse reactions happen with about 7 million patients, and add up to $20.6 billion a year in treatment costs in the U.S, according to the Network for Excellence in Health Innovation.

So why are more seniors landing in the ER now for adverse reactions to drugs that are often part of their daily regimen, compared to before?

“We don’t know why. We were surprised by the finding,” says Nadine Shehab, PharmD, MPH, lead author of the study and a senior scientist with the CDC safety medication program. “We do know that the drugs implicated for older adults require very careful and coordinated management. There are still gaps in managing those medication classes.”

Older adults are often on a cocktail of drugs that treat or prevent many different health issues.

Older adults are often on a cocktail of drugs that treat or prevent many different health issues, such as cholesterol medications, drugs to lower/maintain blood pressure, blood thinners to prevent stroke, diabetes agents, and opioids for managing chronic pain such as arthritis.

“Seniors are on a lot of medications on average, so drug interactions can lead to adverse events, and they don’t work the same as they would in younger people,” says Jonathan Watanabe, PharmD, PhD, a geriatric pharmacist who consults at special clinics for the elderly, and teaches at the University of California, San Diego’s Skaggs School of Pharmacy. “So, we have a higher risk group developing each day.”

More Drugs = More Potential Interactions=  More Side effects

Dr. Mattan Schuchman, a geriatrician and director of Johns Hopkins Home-Based Medicine group, which serves 150 homebound seniors, says colleagues are attuned to the “polypharmacy” approach, where patients take multiple drugs.

“More folks are older and more drugs are now available. For patients already on several drugs, every additional drug we add on increases risk and could have an interaction with other drugs,” he says. He would like to see more data on how falls relate to drug complications. “Being on a drug they did not need to be on may have lead to a fall, but they’re not investigated enough.” Falls are not included in statistics about adverse drug reactions.

Because of the aging process, many drugs that are safe for common use in the general population can cause serious problems among seniors. The American Geriatrics Society created a list called the Beers Criteria of over-the-counter and prescription meds that should be avoided by anyone over the age of 65.

Drugs on the Beers Criteria list are the first suspects when an adverse reaction occurs, but the study noted that only 1.8% of the adverse reaction visits by seniors were for drugs that fell within the BEERS criteria. Named for the geriatrician who created the list in 1991, the BEERS criteria for Potentially Inappropriate Medication Use in Older Adults lists high-risk medications, and serves as a frame of safety reference for prescribing drugs to older adults. It is periodically updated by the American Geriatrics Society.